Reform Update: ACA foes, supporters trade volleys

Democrats and Republicans played another game of political tennis this week when House Republicans served up another vote to fully repeal the Patient Protection and Affordable Care Act and Democrats returned a litany of reasons why the 2010 law is good for Americans.

Hours before the House of Representatives voted 229-195 to approve overturning the entire Affordable Care Act for a third time in a little more than two years, House Speaker John Boehner (R-Ohio) used a tower of the law's regulations—rising more than 7 feet tall—as a prop to emphasize the GOP view that the incredibly complex law is damaging the economy, hurting patients' access to care, and preventing job growth.

And although the Ohio Republican called the Affordable Care Act “the law of the land,” after last November's elections, he did not rule out the possibility of another repeal measure in the future. “When we have further votes,” Boehner said in a news conference, “we'll let you know.”

Just before the lower chamber voted, HHS Secretary Kathleen Sebelius—who has come under fire from Congress this week for her fundraising efforts in support of the law—had an op-ed piece published in the Huffington Post that listed several ways she believes a full repeal of the law would hurt millions of Americans, whether by decreasing access for more than 6 million young adults who are now able to be on their parents' health insurance, denying a tax credit averaging about $4,000 to about 18 million middle-class families next year, or revoking or denying coverage to 129 million Americans with pre-existing conditions.

“Millions of Americans have already benefited from its provisions, and millions more are looking forward to benefits that will soon go into effect,” Sebelius wrote in her commentary. “And in November, the American people re-elected the president as an affirmation of the law's promise that no person should go broke if they get sick.”

Maybe so, but an April tracking poll from the Kaiser Family Foundation found that more than half of Americans (53%) support either continuing to try to change the Affordable Care Act or to stop it altogether, while a troubling 42% said they're unaware of the law's current status. HHS has its work cut out for it as the department embarks on a public education and outreach campaign this summer.

Meanwhile, looking ahead to 2014, are Democrats worried that lack of public awareness about the law, combined with an anticipated bumpy rollout of its major expansions, will hurt their chances at the polls?

Rep. Chris Van Hollen (D-Md.), ranking member on the House Budget Committee, doesn't think so. After the House's repeal vote on Thursday, Van Hollen told Modern Healthcare that millions of Americans are already benefiting from the law and people will learn that that law will provide them with access to quality, affordable healthcare.

“What was today—the 38th time—you heard just a parade of misinformation on the floor of the House about this bill?” Van Hollen said, referring to all of the other repeal-related measures the lower chamber has passed since 2011. “So it's no wonder people are confused. A lot of people are being deliberately confused,” he continued, adding that comments from members on the House floor that the IRS will access people's medical records is “a total bunch of nonsense” and also untrue and misleading. “But you can understand why people are confused,” he added. “But I'm confident we'll be able to implement it.”

Sens. Tom Coburn (R-Okla.) and Richard Burr (N.C.) introduced legislation that would repeal the Affordable Care Act's enhanced federal medical assistance percentage, or Medicaid FMAP. Under the bill—called Preventing an Unrealistic Future Medicaid Augmentation Plans Act—states would still be allowed to expand their Medicaid programs, but they would not have the commitment for increased federal funding. “This bill sends a basic message to governors and state legislatures considering expansion: don't count on the enhanced federal funding for Medicaid expansions, because Congress has overpromised what it can deliver,” Coburn said in a statement. “Realistically, the funding will not be there and the check will bounce.”

HHS announced up to $1 billion in Affordable Care Act funding for the second round of the healthcare reform law's Health Care Innovation Awards. Overseen by the CMS Innovation Center, the initiative will look for proposals in four categories: models that quickly lower Medicare, Medicaid and Children's Health Insurance Program costs in outpatient and/or post-acute settings; improve care for populations with specialized needs; test approaches for specific types of providers to change their financial and clinical models; and improve the health of populations with an emphasis on prevention. Applicants must submit letters of intent June 1-28 and the agency will accept proposals between June 14 and Aug. 15. The CMS expects to announce the awardees early next year, according to Dr. Richard Gilfillan, director of the CMS Innovation Center.

The House Energy and Commerce Subcommittee on Oversight and Investigations announced it will hold a hearing on May 20 to examine health insurance premiums under the Affordable Care Act. At deadline, the panel had not yet included a witness list for the hearing.